Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | OS1-03-5649 | OH |
NPI | 1245632520 |
---|---|
Provider Name | Julie Vondrell-Wiggins |
First Address | Tiffin, OH 44883-2906 |
Second Address | Tiffin, OH 44883-2906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 18/09/2014 |